2012

&

 ,
&

'
,



/ (protons),

(sodium) & (potassium)

 (body fluid) (aqueous

solution) (electrolytes) &
(nonelectrolytes)

COMPOSITION OF BODY FLUIDS

(intracellular) & (extracellular compartment)

10

 ,

(intracellular fluid - ICF)

ICF
(optimal ionic strength)

11

 (extracellular fluid - ECF)

(plasma) (interstitial fluid)
&


CF
(vascular volume)

12

 (extracellular volume)
(interstitial volume)
(28%
)
(plasma volume - 8%)
(transcellular water volume - 4%)

13

 ,
, &

FLUID COMPARTMENTS

EXTRA CELLUAR
FLUID

PLASMA

INTRA CELLULAR
FLUID

INTERSTITIAL
FLUID

TRANSCELLULAR
FLUID

CSF
Intra ocular
Pleural
Peritoneal
Synovial
Digestive Secretions
/

14

 gold standard
(total body water TBW)
(deuterium oxide) &
(tritiated water) (antipyrine)

15

 tritiated water

deuterium oxide

antipyrine
1940s

& 1950s,

16

 (bioelectrical impedance analysis)

( , ECF, ICF & TBW)
&
( )

17

18

 TBW

&
54%
(fractional
water content)
(73% ) &
,

TBW,
54% kg
& 1 kg = 2,2 lb

( 45%
)

,
60% ,
& 40-50%
/

19


(sodium), (chloride) & (bromide)

(mannitol), (inulin) & (sucrose)

20

21

22

 (sodium),
(chloride) & (bicarbonate)

(potassium), (magnesium), (phosphate) &

(proteins)

Cations and Anions in Body

Fluids

Figure 272 (1 of 2)

23



&


Donnan (Donnan equilibrium)

24

25

4%

4%


&




Donnan

26

 &

ICF & ECF

(mEq/L) ICF
ECF,

( & ) ICF

27

:
3 mEq /L 75 mEq /L

:

140 mEq /L 118 mEq /L
:

& 13 mEq /L
,
34 mEq /L

2,3-DPG

ATP &

28

1 (mole) NaCl
2

(osmoles) NaCl
(dissociated) Na+ Cl1 mole D-

1 osmole

1 mole Na3PO4

4 osmoles 3
Na+ 1 PO4329

(mEq/L)

(mEq/L)

(mEq/L)

(mEq/L)

For an element such as Na+, which has a valence of 1, 1 mmol/L = 1 mEq/L,

whereas for a divalent element (i.e. an element having a valence of 2) such as Mg2+
or Ca2+, 1 mmol/L = 2 mEq/L
/

30

31


, ,
()
()

32

, ,
,

33

 ' (osmolarity)

(osmolality)
()
'

Osmosis
No net movement because
hydrostatic pressure = osmotic pressure

Fig. 3.15

units of measurement for osmotic pressure: mm Hg or osmolality

osmolality = osmoles / (Kg solvent)

for a dilute solution: osmolality osmolarity = osmoles / (L solution)
Osmolality is more accurate than osmolarity, because volume varies with temperature, but weight
does not. But, you are more familiar with calculating molarities than molalities. Therefore,

know how to calculate osmolarity.

34

 (colligative property)

, (freezing point),
(boiling point),
(vapor pressure)

'

1kg 1 L 4 C

35

 (osmotic equilibrium) &

(osmolality) &

(extracellular osmolality)

36

 (tonicity)

(hypertonic solution)

, (hypotonic solution)
(isotonic solution)

37


(.. )

Tonicity
of
Solution

Concentration
of
Solute (outside
of cell)

Water

Net
Movem ent

Effect

Isotonic

Same as
cell

Same
as cell

None

None

Hypotonic

Less than
cell

More
than cell

Cell gains
water

Swells,
turgor
pressure

Hypertonic

More than
cell

Less
than cell

Cell loses
water

Shrinks
plasmoly
sis

38


(.. , ),

(.. & )
ECF

5 mOsm/L

39

a+,

a+
,
(, , , , ),

( ,
2)
/

40

&

( )

41

Computation for plasma osmolality

= 2[Na+ ] + [Glucose]/18 + [ BUN ]/2.8

= 2[123 mEq/L] + [98 mg/dL]/18 + [ 22

mg/dL ]/2.8
=246 + 5.44 + 7.86
= 259.3 mOsm/Kg
NV = 275-295 mOsm/Kg

42

a+
2a + /18

Computation for effective plasma

osmolality
= 2 [Na] + [Glucose]/18
= 2 [123] + [98]/18
= 246 + 5.44
= 251.44 mOsm/Kg
NV = 270-285 mOsm/Kg
/

43

 (osmometer)
(effective osmolality)

10mOsm/kg ,

(.. , , )

44

 (osmolal gap)
(, , ,
)
(.. 285 mOsm/L)
(.. 290
mOsm/L) > 10 mOsm/L,


&
/

45

46

 (aquaporins)

11

47

48

A (nephron)
( Bowman)
'
Henle ( )

'

49

50

51

52

53

54

55

 ADH

:1084

56

 ADH (hypothalamus)
(posterior pituitary gland)

(osmoreceptor
cells) ADH

57

(hypothalamic osmoreceptor
cells),
(thirst center)
(cerebral
cortex) ADH

normal osmolality
290 mosm/ l

Water deprivation,
solute ingestion,
diarrhoea etc.

excessive
fluid ingestion
decreased ECF
osmolality

increased ECF
osmolality
HYPOTHALAMIC OSMORECEPTORS

HYPOTHALAMIC OSMORECEPTORS

supraoptic &
paraventricular
Nuclei

supraoptic &
paraventricular
Nuclei

lateral
preoptic
area

lateral
preoptic
area

(supraoptic) &
(paraventricular)

ADH release
from posterior
pituitary

thirst

ADH release
thirst
suppressed suppressed

drink water

CD made water
permeable

ADH

WATER RETENTION by Kidney

/

CD made water
impermeable
WATER EXCRETION by Kidney
58


( 280-295 mOsm/kg)

ADH
2-3%
ADH

2-3%
(<100 mOsm/L)

59

 ADH

(baroreceptors)
(humoral factors)

& ADH

-
ADH, -
ADH,
ADH
,
& ADH

&
ADH

/

60

 ADH
(ethanol) ADH, (lithium) &
(demeclocycline) ADH ,
(chloropropamide) ADH
ADH
(

ADH)

61

 ADH (ADH receptors)

V1
(vasomotor tone) &

V2 (antidiuresis)
V3 ACTH

62

 ADH
2 (aquaporin-2)

Henle

63

 (vasopressinase),
ADH
(1-Deamino-8-Darginine vasopressin - DDAVP)
arginine vasopressin vasopressinase,

64

 10 12

7-mL EDTA

65

 (zona glomerulosa)
(adrenal cortex) 1:1


& ADH

66

67

 &

(aldosterone), 1:1 Na+ K+ H+

68



24
screening test
(primary hyperaldosteronism) Conn,

screening test

,

,


24

69

70

 !
/

71